Department of Urology, Shanghai Changhai Hospital, Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, 200438, China.
J Cancer Res Clin Oncol. 2023 Jul;149(8):4925-4932. doi: 10.1007/s00432-022-04409-z. Epub 2022 Oct 29.
Our study was to determine whether immediate androgen deprivation therapy (ADT) plus radiotherapy (RT) extends survival in men with node-positive prostate cancer (PCa) after radical prostatectomy (RP) compared with those who received ADT alone.
A total of 99 consecutive patients with pathological positive lymph nodes (pN1) PCa were included in this study to receive immediate ADT plus RT (n = 70) or to receive immediate ADT alone (n = 29). The primary endpoint was castration-resistant prostate cancer (CRPC) free survival; the secondary endpoints were distant metastasis-free survival. Cox regression was used to assess the independent risk factors for CRPC.
The median follow-up time was 34.0 (24.8, 47.8) months and 34.25 (23.0, 49.0) months, respectively, in the ADT + RT group and ADT-alone group. The 5-year CRPC-free survival rate was 79.5% and 58.3%, respectively, in the ADT + RT group and ADT-alone group (p = 0.308). The 5-year distant metastasis-free survival rate was 71.4% and 38.8, respectively, in the ADT + RT group and ADT-alone group (p = 0.478). Compared with ADT-alone group, we saw a modest, but no significant improvement in CRPC-free survival and distant metastasis-free survival in ADT + RT group. The results of Cox regression showed that positive lymph nodes ≥ 4 was an independent risk factor for CRPC (p = 0.041).
We found that immediate ADT plus RT compared to ADT alone did not improve CRPC-free and metastasis-free survival. Multivariate Cox regression analyses also indicated that patients with positive lymph nodes < 4 may benefits from ADT plus RT.
本研究旨在确定与单独接受雄激素剥夺治疗（ADT）相比，对于接受根治性前列腺切除术（RP）治疗后病理阳性淋巴结（pN1）前列腺癌（PCa）的男性，即刻给予 ADT 加放疗（RT）是否延长了生存时间。
本研究共纳入 99 例接受根治性前列腺切除术（RP）治疗后病理阳性淋巴结（pN1）前列腺癌（PCa）的患者，分别接受即刻 ADT 加 RT（n=70）或即刻 ADT 单独治疗（n=29）。主要终点为去势抵抗性前列腺癌（CRPC）无进展生存；次要终点为远处转移无进展生存。采用 Cox 回归分析评估 CRPC 的独立危险因素。
ADT+RT 组和 ADT 单一组的中位随访时间分别为 34.0（24.8，47.8）个月和 34.25（23.0，49.0）个月。ADT+RT 组和 ADT 单一组的 5 年 CRPC 无进展生存率分别为 79.5%和 58.3%（p=0.308）。ADT+RT 组和 ADT 单一组的 5 年远处转移无进展生存率分别为 71.4%和 38.8%（p=0.478）。与 ADT 单一组相比，ADT+RT 组在 CRPC 无进展生存和远处转移无进展生存方面略有改善，但无统计学意义。Cox 回归分析结果显示，阳性淋巴结≥4 是 CRPC 的独立危险因素（p=0.041）。
我们发现即刻 ADT 加 RT 与单独 ADT 相比并未改善 CRPC 无进展和转移无进展生存。多因素 Cox 回归分析还表明，阳性淋巴结<4 的患者可能从 ADT 加 RT 中获益。
